Image in radiology| Volume 119, ISSUE 3, P246-247, March 2006

Ring-Enhancing Brain Lesion in a Man with Acquired Immunodeficiency Syndrome

      A 46-year-old Hispanic man with acquired immunodeficiency syndrome (AIDS) and a history of cryptococcal meningitis presented with new-onset simple partial seizures. He had noticed 2 weeks of progressive weakness and numbness of his right arm for which his highly active antiretroviral therapy (HAART) had been discontinued. He denied any fever, weight loss, changes in his vision, or headache. On examination, the patient had oral thrush, was unable to lift his right arm against gravity, had some weakness in his right leg, and sensation was decreased on the right side of his body. Head computed tomography (CT) scan with contrast and a brain magnetic resonance image (MRI) showed a ring-enhancing lesion in the left posterior frontal lobe with surrounding edema, without midline shift (Figure 1, Figure 2). Cerebral spinal fluid (CSF) analysis was within normal limits. No growth of bacteria, mycobacteria, or fungus was noted. Tests for Epstein Barr virus, herpes simplex virus, cytomegalovirus DNA, and the cryptococcal antigen were negative. The patient’s CD4 count was 182 cells/mm3 and the viral load was <400 copies/mm3. He was found to have microcytic anemia with a hemoglobin of 8.4. His urinalysis revealed 4-10 red blood cells/hpf. Toxoplasma gondii serology returned positive for immunoglobulin G and negative for immunoglobulin M. Based on the patient’s head CT findings, he was started on treatment for central nervous system toxoplasmosis and a bacterial brain abscess. Because he showed no clinical improvement and a repeat head CT showed an increase in the size of the lesion, the patient underwent a brain biopsy.
      Figure thumbnail gr1
      Figure 1Brain magnetic resonance image (horizontal view) showing a ring-enhancing lesion in the left posterior frontal lobe with surrounding edema.
      Figure thumbnail gr2
      Figure 2Brain magnetic resonance image (coronal view) showing a ring enhancing lesion in the left posterior frontal lobe with surrounding edema.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to The American Journal of Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Ammassari A.
        • Cingolani A.
        • Pezzotti P.
        • et al.
        AIDS-related focal brain lesions in the era of highly active antiretroviral therapy.
        Neurology. 2000; 55: 1194-1200
        • Gaba A.G.
        • Sparano J.A.
        Metastatic carcinoma.
        AIDS Read. 2003; 13: 547-559
        • Miller R.F.
        • Hall-Craggs M.A.
        • Costa D.C.
        • et al.
        Magnetic resonance imaging, thallium-201 SPET scanning, and laboratory analyses for discrimination of cerebral lymphoma and toxoplasmosis in AIDS.
        Sex Transm Infect. 1998; 74: 259-264
        • Skolasky R.L.
        • Dal Pan G.J.
        • Olivi A.
        • et al.
        HIV-associated primary CNS morbidity and utility of brain biopsy.
        J Neurol Sci. 1999; 163: 32-38
        • Godley P.A.
        • Ataga K.I.
        Renal cell carcinoma.
        Curr Opin Oncol. 2000; 12: 260-264
        • Vogelzang N.J.
        • Stadler W.M.
        Kidney cancer.
        Lancet. 1998; 352: 1691-1696
        • Baynham S.A.
        • Katner H.P.
        • Cleveland K.B.
        Increased prevalence of renal cell carcinoma in patients with HIV infection.
        AIDS Patient Care STDS. 1997; 11: 161-165
        • Gardenswartz M.H.
        • Lerner C.W.
        • Seligson G.R.
        • et al.
        Renal disease in patients with AIDS.
        Clin Nephrol. 1984; 21: 197-204
        • Bleiweiss I.J.
        • Pervez N.K.
        • Hammer G.S.
        • et al.
        Cytomegalovirus-induced adrenal insuffiency and associated renal cell carcinoma in AIDS.
        Mt Sinai J Med. 1986; 53: 676-679
        • Adjiman S.
        • Zerbib M.
        • Flam T.
        • et al.
        Genitourinary tumors and HIV infection.
        Eur Urol. 1990; 18: 61-63